Mace, Jeremy Lee

Mace, Jeremy Lee is an sole proprietor health care provider with primary practice located at 475-750 Rice Canyon Road , Susanville CA 96127. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Mace, Jeremy Lee can be contacted via phone (530) 251-5100.

Contact Information

Primary practice address
475-750 Rice Canyon Road Susanville CA 96127
Phone: (530) 251-5100
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 129074-121 Wisconsin
Behavioral Health & Social Service Providers / Clinical 1041C0700X LCSW74014 California

Profile Details

NPI number 1750719480
LBN Legal business name Mace, Jeremy Lee
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 15th, 2013
Last updated Aug 31st, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750719480 NPPES
Wisconsin MEDICAID 3411849631

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